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V FOR OFFICE USE: � _ APPLICATIONFOR SANITATION PERMIT /. ' 3............. j .c�..... ;.73-- 008' (Complete in Triplicate) Permit No. ....._......•_...... .......................... �-------- This Permit Expires i Year From Date issued Date Issued 7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �I JOB ADDRESS/LOCATION -...----CENSUS TRACT .......................... Owner's Name ...... / :. ._ !�+ .��t - ------------ -------------- ---.---Phone Address . .. ...................................:.. ....�..:.- ...__------------•------------•..._.:---------�-•."Cit �Y�C..dad_.....-......----.._.._.._...........---••--- Contractor's Name .. r.. ... ..........License # _. .` *'�--- Phone Installation will serve: Residen Apartment House❑ Commercial ❑Trailer Court 0 1 Motel ❑Other ...... -•-------------- Number of living units:.. ...�.._ Number of bedrobms ------Garbage.Grinder .......:..... lot Size --re ^.... _.. Water Supply: Public System and (name . .......................... ------- .................. .. Private Character of soil to a depth of 3 feet: Sand o Silt❑ Clay [I Peat❑ Sandy Loam [j Clay Loom.j& Hardpan ❑ Adobe ❑ Fill Material ._.......... If yes, type ...._................ . . (Plot plan, showing size of lot, location of system in relation to"-wells„buildings, etc. must be placed on reverse side.)► NEW INSTALLATION: (No septic i.tank or seepage pit permitted if�'svbiic sewer is available within 200 feet,] . PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size,..--------.---_-----_- ........ ....... Liquid Depth .......................... Capacity .1 ---......... Type -------------------- Material----................... No. Compartments ........... !) Distance to nearest: Well . . .........:..........__-........Foundation ----------- ..... Prop. Line --- .................. LEACHING LINE [ ) No. of Lines N-- ---- Length of each line.... .......I..... Total Length ._.._...,..__.__--__---.-._. 'D' Box ..I Type Fil}er Material ..... _- -------Depth-iilter Material ...................................I........ .- Distance thoh ndarest: Well .. ............. _.'.7.-Foundation ---_---_---._------ Property Line ---•.-----------..-_--.- SEEPAGE PIT [ ) Depth . .iI,.. Diameter .............. . Number ................._.._..._.., Rock Filled Yes ❑ No ❑ Water Table Depth .............. •- --••----------•------------..•Rock Size ......-- ..-----------_.... p . Distance to nearest: Well ............:...........................Foundation ..._._....-......... Prop. Line .... ................. REPAIR/ADDITION(Prev. Sanitation Permit# .............. ..............._. --- Date ---•- -------------------------- IpI Septic Tank�lSpecify Requirements) ........- -��?-...:. ..------•-----•----•----------------------•--..........--------........-----.._..........- ---------. Disposal Field (Specify Requirements) ...... ----------------------- ----- ------- ..................... ...... ----------- ............. I ---33._..P4_ -.. 0�cro.a v.6-f- _..- .......... . ............................ ------.-_ ------- .......... -- ---------- ------ , 11 (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies tate following: "I certify that in the-performance of the work for which this permit is issued, I snail not employ any person in such manner as to become subject to Workman's Compensation laws of California.” Signed .:..... ....- - I� g ------------ ............... Owner - ,M By -- ...._.._.._i Title .. ....... ..... (If other than owner) �! DEP RTMENT USE ONLY APPLICATION ACCEPTED BY ........h .. ..-.. ---.--- -• ....----- ... DATE .. .�G... _..j/�- ... .? BUILDING PERMIT ISSUED ........ . . . . ................... .................................. ..............DATE _.. .. ADDITIONAL CMENT _.. ----------------------- - -----.... ----...........•----- .................. ,.. ......................................_...... _.... .__ .... . ..... ----------------------------- .....................•-_. ...... -• ---------... ----••--•------ --------.... ...-........... Final Inspection bY: ... .._. ........ ' ..Date .... � 1/=. .•.- -- ' N J AQUIN LOCAL HEALTH DISTRICT E.'H. 13 ,24 1-'68 Rev. 5M �F 71723 M l